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Thursday, July 23, 2009

Pandora's Box, Covert Rationing,

Last week Health Care Reform took a brief break surpassed by the passing of Michael Jackson. The news cycle remained in that mode for an unprecedented 72 hours.

This week confusion, chaos, and indecision reigns once again.

Numerous bloggers, official and unofficial weigh in on “Pandora’s Box”.

Dr Rich posting on Better Health:

Even with the soaring popularity of our new President, and the general feelings of goodwill projected toward him by Americans and non-Americans alike, and despite the fact that the party he leads holds large majorities in both houses of Congress, and despite the general agreement by both political parties and by all the major stakeholders in the healthcare universe that the time has finally arrived for substantial reform, one gets the sense that Mr. Obama is losing some of the initiative on his healthcare reform plan.

Some of the leaders in the Democratic party (who, really, are the only ones who count) have balked at the price tag that has been attached to the Obama proposals (estimated currently at $1.5 trillion over 10 years, and most admit this projection uses the rosiest of assumptions), and now they’re balking as well at the much-desired (by the Obama administration, at least) “public option,” the Medicare-like insurance plan for all……more, click above.

To see why, one simply needs to consider for a few minutes those alternate reform proposals now circulating amongst policy wonks. DrRich will briefly describe three of these alternative proposals, ones that seem to have gained at least some traction, and which may on the surface seem to be quite good (and thus the most threatening to the Obama plan). Then he will demonstrate why these plans simply cannot work.

The Healthy Americans Act, sponsored by Sen. Ron Wyden (D-Oregon), requires that individuals buy private health insurance that at a minimum would offer “Blue Cross standard” care. Individuals would be able to afford this insurance (which will be available to all regardless of age or medical history) because everybody would get a big raise (by statute) when their employers no longer have to buy it for them. People earning less than 400% of the poverty level would receive government subsidies to purchase their own insurance. The Wyden plan has the great advantage of having been “certified” as being budget-neutral by 2014 - so “officially” it would be a trillion or two cheaper than the Obama plan over the next decade.

The Patients’ Choice Act, sponsored by four Republican Congressmen (Coburn, Burr, Ryan and Nunes), also places ownership of health insurance in the hands of individuals, instead of the employers. Individuals will buy their own insurance, which will be available to all, and which will be available through one-stop shopping via state-run “regional insurance exchanges.” Families will recieve a tax credit of $5700 ($2300 for individuals) to purchase this insurance, and those with low-income would receive further subsidies. Those who do not make an active insurance choice will be automatically enrolled in a private plan paid for by the tax credit.

And finally (finally for this blog post, at least), there is Bob Laszewski’s proposal, the Health Care Affordability model. Laszewski is a noted healthcare blogger and well-respected policy expert, and accordingly, his proposal is being taken quite seriously by some members of Congress. Laszewski is so smart and his proposal is so detailed that one with DrRich’s limited capacity has difficulty getting through the whole thing. But essentially he proposes to have the feds set formal cost-cutting targets which every private health plan must meet. Those who fail to meet these targets will lose their tax advantages (i.e., companies that continue to provide their products will no longer get tax deductions). Clearly, this will provide a strong incentive for insurance companies to meet those cost targets, and healthcare costs will, accordingly, eventually come under control. Lazsewski emphasizes that his proposal is not really a stand-alone plan, but can be attached to any other plan that’s out there. It will simply give insurance companies the added incentives they need to actually cut costs.

Health Care Reform: Putting Patients First

Elected Officials JoinAmerica’s Top Medical Bloggers to Discuss the Real,

Clinical Impact of Health Care Reform

WHAT: As the health care debate heats up on the Hill, join Representative Paul Ryan as he sits down with top medical bloggers from across the country to discuss health care reform and its impact on practicing clinicians. This keynote discussion will be followed by two panels of physician and nurse bloggers who will highlight the importance of putting patients first. Topics covered will include key barriers to health care quality, affordability, and access as well as the potential pitfalls of a new public plan and ways to fix the current system without investing billions in a new one.

Jim Herndon, M.D., past president of the American Academy of Orthopaedic Surgeons and Better Health contributor

When the biggest retailer in the country says employers should be required to contribute to their employees’ health-care costs, even as business groups are pushing hard against such an idea, there’s sure to be a fight.

So, two weeks after Wal-Mart backed an employer mandate as part of health reform, the National Retail Federation has written an open letter, attacking the position. Here’s the WSJ’s story; here are a few choice lines from the letter itself:

Seeing the company in lock-step with the unions on this issue was troubling to say the least. Although the move may provide a short-term public relations boost to Wal-Mart, it could have long-lasting, devastating consequences to retailers throughout the country.

The letter’s core argument is that if employers were required to spend money on their employees’ health care, they would be forced to raise prices or reduce payrolls.

Wal-Mart’s own letter from two weeks earlier, co-signed by leaders of the union SEIU and a left-leaning think tank, argued that the current system, which leaves millions uninsured, is economically inefficient. The letter continued:

Not every business can make the same contribution, but everyone must make some contribution. We are for an employer mandate which is fair and broad in its coverage …

Health Blog Question of the Day: Should employers be required to help fund health insurance?

Speak to Me

by Rob on July 12, 2009

(+2 rating, 2 votes)

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The name of the conference is “Putting Patients First.” So how can we have the audacity to say that we stand for patients without having patients on the panel? Aren’t we just going to beat the drum of our own self-interest but do it in the guise of speaking on the behalf of the patient?

The danger is there.

I won’t pretend that I don’t have some selfish reasons to enter the healthcare debate. I make my living off the system and a seriously flawed plan could significantly decrease my income. I don’t want to earn less. Is that selfish? Of course it is!

So to make sure that I don’t go too far in that direction and so that I don’t have mistaken ideas of the patients’ perspectives, I want to open the floor for discussion. I want to hear from patients, doctors, patient advocates, economists, llamas, mascots, and anyone else with opinions on the subject. I will only say what I believe, but I am very open to change what I believe, understanding that what I think is based on my own limited experience.

I am very happy that folks like Duncan Cross will be at the conference and e-Patient Dave and others are wanting to contribute their opinion (this post stemmed from a Twitter conversation with Dave and others). This is what keeps us honest. I do intend on representing patients and feel that I have a lot to contribute on this issue. I see thousands of people each month and have a wide range of experience with people’s problems with our system. I really get angry when I see suffering as a result of the stupidity of our system; I have enough to deal with from the usual causes of suffering. Our system is supposed to make things better, but it often does the opposite.

That’s a lot of reading, I know. Pick and choose. The bottom-line is that I don’t care how the system gets fixed; I just want that fix to be what is best for the patients I take care of – one that lets me take the best care of them possible.

What do YOU think I need to address when in Washington? You don’t have to agree with my opinions. I want to know.

After all, that’s the American way: work hard, put your nose to the grindstone, get good grades, be obsessively perfectionistic, then you’ll be rewarded if you just stay with it long enough. It’s the myth that perpetuated through medical school, residency and fellowship, and our poor residents, purposefully shielded from the workload they’re about to inherit, march on.

But then they graduate and find that just as the population is aging, chronic and infectious diseases are becoming more challenging, health advances and potential are exploding. Just then, we decide to launch a full scale attack on physicians and their patients with increased documentation requirements, call hours, larger geographic coverage of their specialties, reduced ancillary workforce, and shorter patient vists.

Physicians get it - burn out and dissatisfaction are higher now than ever before. This is probably the greatest real threat to the doctor-patient relationship and health care reform discussions don’t even put it this on the table.

At the same time that we expect our doctors to be devoted, available, enthusiastic, meticulous and at the top of their game with perfect “quality” and “perfect performance,” while simultaneously cutting their pay, increasing documentation reqirements and oversight, limiting independence, questioning their professional judgment, and extending their working hours. We must become more efficient!

Disclaimer

The opinions in this blog or other forms of social media are solely that of Gary M. Levin M.D. Dr. Levin has no financial interests in any medical devices which are discussed or which appear in the blog. Commentary taken from other sources are either quoted or referenced with attribution. Dr Levin does not endorse, nor give financial support to any political organizations.